The Medical Marijuana Guide: Cannabis and Your Health

After decades of misinformation about cannabis largely due to the well-funded propaganda campaign in the 1930s, public attitudes toward the drug have finally begun to evolve. In 1996, California became the first state to legalize medical marijuana and since then, 28 other states, 2 U.S. territories, and the District of Columbia have followed suit. Now countless patients are reaping the benefits of this amazing resource which has been used to effectively treat everything from chronic pain to debilitating illnesses.
In The Medical Marijuana Guide: Cannabis and Your Health, Dr. Patricia Frye takes a direct, no-nonsense approach to educating readers about cannabis and its medicinal qualities. After having retired from medicine, Dr. Frye was offered an opportunity to practice cannabis treatment. Intrigued, she educated herself on this emerging alternative and is now ready to share with others what she has learned.
In this book, using humorous and touching stories from the many situations she has encountered in her practice over the years, Dr. Frye provides valuable information about the undeniable medicinal qualities of cannabis. This book helps to de-stigmatize this misunderstood drug and educate readers on the history of cannabis and how it is used by the medical community today. This is an accessible, enjoyable resource that will not only entertain readers, but may change their lives for the better.

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Chapter 4
Laboratory Testing
Cannabis itself is a very safe plant, and no one has ever died from a cannabis overdose. However, it is a plant, and plants can be diseased or contaminated with such biologicals as mold, bacteria, and toxins, which are poisons produced by organisms that grow on the plant. They can also contain chemicals, like heavy metals, residual solvents from processing techniques, or pesticides. Cannabis products from the dispensary should be tested not only for cannabinoid and terpene profiles but for all of these possible contaminants as well.
Infestation
When mold spores on the plant are inhaled, they are deposited in the lungs, where they can cause infection. A patient with an intact immune system will most likely fight off any infection, but those whose immunity is compromised, like patients with AIDS or those receiving chemotherapy, are at risk of developing infection—which can be deadly.
Two Northern California patients undergoing chemotherapy and using medical cannabis developed rare fungal infections. One patient, who was also receiving stem-cell treatments, was nebulizing medical cannabis in an aerosol to alleviate the nausea and vomiting associated with the chemotherapy. He subsequently died from the infection.
When specimens from several California dispensaries were tested, they were found to be contaminated with multiple bacteria—Klebsiella, Pseudomonas, E. coli, Acinetobacter, and Stenotrophomonas.1 While the heat from smoking cannabis might have killed the fungus, it is not guaranteed that all of the microbes will die. Ingestion of alcohol-based tinctures and cooked products might be a safer alternative for at-risk patients.
Until this year, laboratory-testing requirements in California varied from county to county. Beginning January 1, 2018, the California Medical Cannabis Regulation and Safety Act, passed in 2015, went into effect, creating a comprehensive state-licensing system for commercial cultivation, processing, retail sale, transport, distribution, delivery, and testing of medical cannabis.2
Toxins
Aflatoxins are poisonous substances produced by the mold Aspergillus. These toxins can contaminate agricultural products like corn, peanuts, and grains during production, harvest, or storage. Highly toxic to the liver, exposure to aflatoxins is also associated with the development of liver cancer.3
Residual Solvents
Concentrates are made by carbon dioxide extraction or by using a variety of light hydrocarbon solvents, like butane, hexane, and propane. Not only are the cannabinoids and terpenes concentrated, but any pesticides on the plant will be concentrated as well. In carbon dioxide extraction, pressure and temperature are used to turn the carbon dioxide gas into a liquid. That liquid is then used to extract the plant’s medicinal compounds.
Butane, hexane, and propane are also used to extract the medicinal components from the plant. This method of extraction, better at concentrating not only the cannabinoids but also the terpenes (which may not be extracted as efficiently by safer methods like carbon dioxide extraction) makes high-quality and highly pure medicine and can be very safe and effective if the solvent is removed properly.
These solvents are often used because the extraction method is cheaper, but it is very important to remove the residual solvents from these concentrates before they are used in cannabis medicine for ingestion or inhalation. This additional step requires close monitoring and state-of-the-art equipment, which increases the processor’s cost, so many unscrupulous businesses skip it in order to increase their profit margins.4
Cannabinoids and Terpenes
The labs typically test for ten cannabinoids: delta-9 THC, THCV, CBD, CBDV, CBG, CBC, CBN, CBGA, CBDA, and THCA. They report the percentage of each cannabinoid found in the plant, usually 4 or 5 percent. Once the product is labeled for the patient, it usually lists the concentrations of CBD, THC, and sometimes CBN or CBG. Labs test for a larger variety of terpenes, around 30 to 40, in the plant than cannabinoids, but they are found in much lower concentrations and generally yield about 8 to 10. The terpene concentrations are usually about 1 to 3 percent in the flowers but can be as high as 8 percent in concentrates.5
Pesticides and Heavy Metals
Cannabis is an environmental cleaner. It absorbs pesticides and heavy metals, like cadmium, arsenic, mercury, and lead found in the air, soil, and water. For cannabis grown in soil outdoors, any pesticide residue in the soil from prior crops can be absorbed into the plant, even if the chemicals are not actively used to prevent infestation of cannabis. While there are some legitimately pesticide-free cannabis growers, for the most part, when cannabis is grown outside of state regulatory guidelines, the plants are typically laden with pesticides. The clone or starter plant is often dipped in pesticide and then is sprayed every week or so, whether there are any signs of infestation or not. Furthermore, because cannabis is not a USDA-recognized crop, there are no pesticides approved for use on cannabis plants.
In 2016, a Northern California cannabis testing lab found that 84 percent of the medical cannabis samples tested positive for large amounts of pesticides. More than 65 percent of the samples were positive for myclobutanil, the active ingredient in Eagle 20. This pesticide is particularly effective in treating powdery mildew, a fungal disease that affects a number of plant varieties, including cannabis. When burned, myclobutanil turns into hydrogen cyanide.6 Cyanide is known to have deleterious effects on the brain, nervous system, and heart.
The state of Colorado allows for the use of pesticides in cannabis cultivation, but the pesticides must be used in accordance with its labeled directions. The label must allow for use on unspecified crops or plants, for use at the site (e.g., greenhouse vs. outdoors), and for use on crops for human consumption.7 The problem with this is that there is a difference between consumption and inhalation, and for patients who smoke or vaporize, it is not known if there are any adverse effects.
What about Organic?
Technically speaking, cannabis cannot be certified organic because of its federal status. The US Department of Agriculture does not recognize it as a legitimate crop, it cannot be USDA-certified organic. If anyone says their cannabis is organic, then they are not familiar with the workings of the organic program.
Established in 2004, Clean Green Certified is an independent industry organization that certifies cannabis cultivators that use natural or organic methods to grow cannabis and control pests. Chris Van Hook is a cannabis compliance and organic industry attorney and founder and director of Clean Green, a USDA National Organic Program–accredited organic certification company, of which there are only 84 globally. The Clean Green program certifies cannabis flower and products based on the federal USDA program. Not only are the flowers and products inspected by trained agricultural inspectors, but Clean Green also conducts yearly collection and testing of the soil that the plants are grown in. Soil samples are sent to a federally licensed agricultural laboratory, where they are screened for 75 indicator compounds, including synthetic pesticides, fungicides, and other prohibited synthetic compounds.
The Clean Green program tests every certified grower every year in order to renew their certification. In addition to testing for pesticides and other prohibited synthetic inputs, a general agricultural inspection is conducted of the growing and handling conditions of the certified crops. Field conditions, including dust control, are inspected, as well as are the postharvest-drying and processing areas and procedures. The goal is to ensure that proper crop production and handling standards are maintained at farms.
Once a certified crop has left a farm, a separate certification process follows the crop to the processor. This certification currently includes the making of processed cannabis products, such as pre-rolls, oils, tinctures, body-care products, and cannabis-infused food products (commonly called edibles). This certification follows the products through to the final retail packaging of the Clean Green Certified products and to the retail outlet. In this manner, similar to the USDA National Organic Program, the cannabis consumer can be confident when selecting a processed product or packaged flower with the Clean Green logo that there has been a qualified, nonconflicted, third-party certification of that purchase from seed to the final patient or consumer.
Clean Green Certified inspectors who are either USDA inspectors or are qualified to be USDA inspectors conduct inspections on-site. Clean Green also evaluates producers and processors for fair labor and fair-trade practices, their carbon-footprint-reduction program, sustainability, water conservation, and legal water sources. Only cannabis businesses that can show compliance with their state laws may apply for a Clean Green Certification. In 2017, Clean Green certified approximately 60,000 pounds of cannabis in California, Oregon, Washington, Montana, Colorado, and Nevada. Anything certifiable under the national organic program is certifiable under the Clean Green program.
The framework that already exists for soil type, cutting solution, and pest-control mechanisms that are allowed under the national organic program is allowed in Clean Green. Again, because there are no registered pesticides for cannabis, to be legally compliant with federal pesticide laws a cannabis producer may only use products deemed so nontoxic that they do not need a federal registration for their use.
If a dispensary claims that their products are organic, then they are either not being truthful or they may think that “pesticide-free” means “organic.” If they state that their products are Clean Green certified, it is important to ask to see the certificate number for either the cultivator or producer. You can then verify the claim by going to www.cleangreencert.com.
Summary
You should assume that any cannabis flower acquired in the community will be significantly contaminated with mold, bacteria, and possibly pesticides. Tinctures, vape oils, and cartridges filled with oils will probably be made with the use of butane or propane, and there is a good chance those solvents are present in the oil.
I often hear complaints that dispensary medicine is so much more expensive when compared to what you pay for cannabis sold in the neighborhood. That may be true. The states that regulate the cultivators and processors hold them to a higher standard to produce a healthy product. It is expensive to control for climate, humidity, infection, and light and to pay for state-of-the-art cultivation centers, supercritical carbon dioxide extractors, sophisticated extraction machines, laboratory testing, chemists, plant biologists, and seed-to-sale tracking. Like most things, you get what you pay for. The illegal cannabis producer is not in business for your health, and any shortcuts to cut costs and prevent loss will be taken, regardless of whether it is in the best interest of the consumer.
When purchasing cannabis, even from a dispensary, it is advised to only purchase products that have been tested by a reputable, accredited, state-licensed, third-party laboratory. This is especially important for a patient in an immune-compromised state due to chemotherapy, AIDS, or any other condition. In some areas, the patient can take their product to licensed laboratories for testing.
In both California and Oregon, there have even been problems with community-acquired as well as dispensary-issued medical cannabis. California, until 2018, did not require testing at a statewide level, although some counties required it. Unfortunately, even where testing was mandated, without state government oversight, several laboratories were found to be falsifying results to suit the needs of the growers and processors. Not only were they falsifying the reports of THC concentrations in the products, but they were also falsely reporting lower concentrations of pesticides and other contaminants on the plants and in the extracts and concentrates.
Always ask if products have been tested by an accredited, licensed, third-party lab, and make note of the laboratory that does the testing. It is not safe to use any cannabis product—flower, oil, or concentrate—that has not been tested. Laboratory testing is not mandated in every state, and not all laboratories give honest results. If you live in a state that does not require testing or if you are purchasing cannabis in the community, be wary because labels can be deceiving! If you have an immunodeficiency, avoid inhalation, and try to use alcohol-based tinctures or cooked product.
Contents
Acknowledgments
Introduction
1 History of Cannabis: The Journey from Medicine to Intoxicant and Back Again
2 Legalization
3 Cannabinoids, Terpenes, and Flavonoids
4 Laboratory Testing
5 Clinical Conditions
6 Adverse Effects Associated with Cannabis Use for Medical Problems
7 First Doctor’s Visit: Start with Your Provider
8 Ways to Medicate
9 Making Your Own Medicine
10 Hemp-Derived Cannabidiol (CBD)
11 Self-Care: Toning Your Endocannabinoid System
Appendix: Lists of Drugs by Metabolism
Notes
Works Cited
Index
About the Author
Chapter 1
History of Cannabis
The Journey from Medicine to Intoxicant and Back Again
There was a time when American doctors were able to write prescriptions for cannabis extracts, called tinctures, and salves to treat ailments like migraines, parasites, seizures, pain, and melancholy. It was not a perfect medicine. Dosing could be challenging because no one knew exactly why or how it worked, but most of the time it did work. Except for occasions when a patient was given a vial of cannabis tincture that was stronger than expected and experienced the effects of too much Δ-9-tetrahydrocannabinol (THC), it was safe—so safe, in fact, that no one died.
It is important for both patients and health-care providers to have an understanding of the history of cannabis as a medicine and intoxicant and the series of events that led to every type of the cannabis plant, both fibrous and drug type, to be declared an international public menace and relegated to an illegal, black-market, recreational street drug. With some awareness of the politically and financially motivated efforts to remove cannabis from the physician’s toolbox, I think you just might have a better appreciation for this effective and remarkably safe medicinal.
Agricultural Beginnings
Although human beings emerged about 250,000 years ago, according to archeological evidence, agriculture is a relatively modern invention, at only about 12,000 years old, with some tantalizing evidence of plant cultivation as early as 23,000 years ago.1 Prior to cultivation, humans were hunters and gatherers, foraging wild berries and plants and following the migratory paths of wild animals. Cultivation was one of the first things that set man apart from other creatures inhabiting the earth. It was man’s first attempt at manipulating the environment to suit his needs, and it was the necessary first step toward many technological advances.
Cannabis is certainly one of the first, and perhaps the oldest, cultivated plant, and it played an important role in mankind’s beginnings. Cannabis hemp cord was identified in pottery in a Taiwanese village site dating back at least 10,000 years. Cannabis seeds and oil were used for food in China as early as 6,000 BC, and 4,000 years before the birth of Christ, hemp fibers were used for textiles in China and Turkestan.2
Ancient Medicine
Cannabis, called má, is one of the 50 fundamental herbs of Chinese medicine. Pharmacologist Emperor Shen Nung wrote a book on treatment methods in 2737 BC, which included the medical benefits of má. The Pen Ts’ao Ching, written in 1 AD, is based on traditions from the time of Shen Nung and is the oldest known pharmacopoeia. Cannabis was recommended for more than 100 conditions, including gout, malaria, poor memory, and rheumatism.
Hua Tuo (140–208 AD) is credited with being the first healer to use cannabis as an anesthetic. He mixed pulverized cannabis plants with wine and acupuncture to locally and systemically anesthetize patients for wound cleaning and pain control.3
In 1993, a 2,500-year-old mummy was discovered in the permafrost of Ukok Plateau in the Altai Mountains of eastern Russia near the Chinese border, an especially cold and dry region. With the inadvertent help of grave robbers, whose disturbance of her tomb allowed water to enter and freeze, the Siberian Ice Maiden (also known as the Princess of Ukok) was so well preserved that even her elaborate tattoos were intact. Anthropologists were able to ascertain what medical conditions she suffered from. MRI scans revealed that the young woman had a malignant tumor in the right breast, with metastasis to the right axillary lymph nodes and spine. The scans also showed that she suffered from osteomyelitis, an infection in the bone, and a skull fracture and other injuries, including a dislocated right hip, consistent with possibly falling off a horse.
This 20-something-year-old was obviously a person of significant stature and prestige. Her coffin was elongated to accommodate a three-foot headdress. Also in the burial chamber (or kurgan, of the Pazyryk culture) were two small tables with serving trays holding horsemeat, mutton, yogurt, coriander seeds, a beverage—and a pouch containing cannabis.4 While we don’t know for sure that she used cannabis to control the excruciating pain she must have experienced, it’s highly likely that she did.
There has been much debate over a passage in the Old Testament in which God gives Moses the recipe for holy anointing oil, often translated as “sweet calamus.” Exodus 30:23–25 reads,
Take thou also unto thee principal spices, of pure myrrh five hundred shekels, and of sweet cinnamon half so much, even two hundred and fifty shekels, and of kaneh bosem two hundred and fifty shekels. And of cassia five hundred shekels, after the shekel of the sanctuary, and of oil olive an hin. And thou shalt make it an oil of holy ointment, an ointment compound after the art of the apothecary: it shall be a holy anointing oil.
In 1937, Sula Benet, a Polish anthropologist and professor at Hunter College who specialized in longevity and Eastern European culture, wrote that the Hebrew word kaneh means both “hemp” and “reed.” I also spoke with a physician from the Israeli Ministry of Health, who asserted that Kaneh-bos (singular) translates to “aromatic cane” and that, indeed, the Hebrew term kaneh bosem found here means “cannabis” and was an ingredient in holy anointing oil.
Ibn Sina (b. 980), the Persian philosopher and scientist, is best known as the physician who wrote The Canon of Medicine, probably the most advanced scientific medical textbook available in its day. Written in Arabic, the Canon was translated into European languages and was widely used as a reference in Western universities until well into the seventeenth century. The Canon of Medicine makes various references to “Kunnabis” in the treatment of ear infections, skin rashes, and inflammation. In addition, it warns of the problem of using too many leaves.5
Cannabis (vijaya in Sanskrit) is indigenous to India and is found in more than 80 traditional Ayurvedic formulas. It is recognized as a powerful herb with the ability to both heal and poison and is recommended in only very small doses and always in combination with herbs that balance its effects. It is used to treat pain, digestive disorders, and dysentery and to enhance sexuality. It is known to improve digestion; relieve anxiety; and treat glaucoma, swelling, and diabetes. Its dry, hot, and penetrating qualities are said to have a long-term negative impact on reproductive tissue, and “overuse can lead to dry, weak, brittle tissues.”6 In fact, excessive cannabis use can affect sexual hormone production in both men and women and can negatively affect fertility.
The Materia Medica of Indian Herbalism, published in 1841, notes that long-term consequences of cannabis use can include indigestion, tissue depletion, melancholia, and impotence. Excessive doses can cause “mental exaltation, intoxication, a sense of double consciousness, memory loss and gloominess.”7 It is known as a tamasic drug, which means that, if used in excess, it could dull the mind, affect memory, and cause spiritual confusion. In Ayurveda, the patient is discouraged from smoking because the qualities of smoke are heating, penetrating, and drying. They are encouraged to use cannabis as an edible and along with other herbs or foods to make it less damaging. It is thought that milk balances the negative qualities of cannabis. Traditionally bhang, a cannabis milkshake consumed during certain Hindu festivals, is made by boiling leaves in milk with dates, sugar, saffron, cardamom, rose petals, and almond meal.
Western Medicine
Dr. William Brooke O’Shaughnessy (b. 1809) was an Irish physician, surgeon, and chemist who, in addition to his work with cannabis, would later lay the groundwork for intravenous fluid and electrolyte replacement in the treatment of cholera. After graduating from the University of Edinburgh in 1829, he joined the British East India Company in 1833 and moved to Calcutta. There, he served on the committee of the Materia Medica and later as chemical examiner, developing methods for forensic studies to detect arsenic poisoning and other botanical poisons. He was a member of the Medical and Physical Society of Calcutta, where he published one of his first papers on the medical application of cannabis, “Case of Tetanus, Cured by a Preparation of Hemp (the Cannabis Indica),” in 1839. In 1841, O’Shaughnessy returned to England, where he introduced the use of cannabis to Western (European) medicine.
Dr. O’Shaughnessy wrote of his successful treatment with cannabis in “On the Preparations of the Indian Hemp, or Gunjah,” published in the Provincial Medical Journal, which included “Their Effects on the Animal System in Health, and Their Utility in the Treatment of Tetanus and Other Convulsive Diseases,” “Cases of Rheumatism Treated by Hemp,” “Case of Hydrophobia [Rabies],” “Use in Cholera,” “Use in Tetanus,” and “Case of Infantile Convulsions.”8 I have been particularly taken with Dr. O’Shaughnessy’s account of the baby girl with infantile spasms. He meticulously chronicled the condition of the baby and the devastating effects of the constant seizing. His description of how he gradually increased, or titrated, the dose until her body responded to the medicine parallels much of what parents and cannabis clinicians of today have found. In his article, the infant responds at first, but at a later date, the spasms start again. Again, he administered the cannabis tincture, slowly increasing the dose, but he had to give a lot more than the first time. He marveled that the amount needed by the baby was on par with the dose a much older person had taken during an experiment and that, while that amount was intoxicating to the young adult, it did not appear to have any deleterious effects on the baby. It so beautifully illustrates how each batch of medicine may be slightly different, how younger people appear to tolerate much higher doses than do older people, and how every person responds to cannabis differently—all important things to consider when recommending dosing.
The New World
Hemp was such a valued commodity and had so many uses that it was a required crop in the 13 original colonies. It was used as food and to make cloth and rope. In times of shortage, one could be jailed for failing to grow Cannabis sativa.
It was also recognized for its medical benefits and was added to the list of approved drugs and treatments, the US Pharmacopoeia, in 1850. Companies like Eli Lilly, Park Davis, and E. and Wm. S. Merrell produced cannabis tinctures that were commonly prescribed for migraines, melancholia, pain, muscle spasms, and seizures. While it was widely used during the second half of the nineteenth century, it began to fall out of favor with the advent of pharmaceutical tablets like aspirin and morphine, which were much easier to dose. Produced as a tincture (a plant extract in alcohol or oil), it was impossible to know the concentration of the psychoactive component, THC, so it was not uncommon for patients to take too high a dose and suffer the adverse effects—dizziness, mental confusion, anxiety, and paranoia.
Twentieth- and Twenty-First-Century Medicine, Regulations, and Politics
Pure Food and Drugs Act of 1906
During this period, excessive opium and cocaine use was creating problems with addiction. These substances were used in products from Coca-Cola to bogus patent medicines for coughs, pain, and discomfort associated with tuberculosis to even teething medicine for babies. As the addiction problem grew, medicines thought to be less addicting than morphine, like heroin (later found to be more addicting), were developed and prescribed.9
As a result, there was an increased social concern that the public was unknowingly using addictive substances. In 1906, the federal Pure Food and Drugs Act was passed for the purpose of “preventing the manufacture, sale, or transportation of adulterated or misbranded or poisonous or deleterious foods, drugs, medicines, and liquors” and required that the “quantity of any alcohol, morphine, opium, cocaine, heroin, alpha or beta cocaine, chloroform, cannabis indica, chloral hydrate, or acetanilide, or any derivative or preparation of any such substances contained therein” be present on the label.10 With that, the bottles of cannabis tinctures identified the variety of cannabis, the suggested dose, warnings, and sometimes a skull and crossbones symbol, with instructions on what to do for accidental poisonings. Quite naturally, this was cause for concern for some patients. Around this time, there was also a growing sentiment against any type of intoxicant, including alcohol, and the temperance movement was in full swing. The Eighteenth Amendment was ratified in 1919 and remained in effect for 14 years, until it was repealed in 1933.11
William Randolph Hearst and the “Mexican Problem”
Many Mexican laborers and migrant workers used cannabis to relieve stress, without the hangover associated with alcohol. It was also used by the soldiers in Pancho Villa’s army during the Mexican Revolution (1910–1920).12 Newspaper magnate William Randolph Hearst was known to have a particular hatred for Mexicans and Mexican Americans, possibly fueled by the loss of 800,000 acres of timberland to Pancho Villa during the Mexican Revolution. He used his newspapers to portray Mexicans as lazy, violent, marijuana-smoking degenerates who stole jobs from white Americans.13 After the 1929 stock market crash, Americans were faced with the massive unemployment of the Great Depression, and Hearst’s racist propaganda fueled the growing anti-immigrant sentiment by citizens who believed that these foreigners were taking their jobs away.
Prior to the federal ban that occurred in the 1930s, states with larger Mexican populations, like California (1913), Wyoming (1915), Texas (1919), Arkansas (1923), Iowa (1923), Nevada (1923), Oregon (1923), Washington (1923), Montana (1927), and Nebraska (1927), had made recreational use of cannabis illegal. These laws tended to be specifically targeted against the Mexican American population. The Butte Montana Standard reported a legislator’s comment: “When some beet field peon takes a few traces of this stuff . . . he thinks he has just been elected president of Mexico, so he starts out to execute all his political enemies.”14
The Decorticator and the Antihemp Campaign
In 1919, George W. Schlichten patented a newly designed decorticator, a machine that could strip the fiber from any plant without first having to soak the plant. It was the first time hemp could be processed efficiently at an industrial level, and it didn’t take long before the potential for hemp to be used in paper and other products on a large scale was realized. Hemp was also used to make canvas, sails, paint, rope, and clothing. In the late 1920s, Lammot du Pont began working on polymers to make plastics like neoprene and synthetic rubber and in 1935 introduced his new synthetic fiber, nylon. It has been speculated that mass-producing products from hemp would seriously affect the value of timberland owned by Hearst and others and the synthetic paints and fibers produced by du Pont.
Harry J. Anslinger and the Federal Bureau of Narcotics
In 1930, Harry J. Anslinger was appointed commissioner of the US Treasury Department’s newly founded Federal Bureau of Narcotics by financier, Andrew Mellon, his wife’s uncle. Anslinger built his career on alcohol prohibition and enforcement and supported the criminalization of drugs, but prior to 1930, Anslinger had voiced a different assessment of cannabis—that it was not a problem and that it did not harm people.15 However, some believe that, with the end of alcohol prohibition in 1933, he was in need of a new substance to police and control, so cannabis became the target.
Thus began the campaign of distortions, mistruths, and lies about the effects of cannabis, supported by mass media and the yellow journalism of William Randolph Hearst:
By the tons it is coming into this country—the deadly, dreadful poison that racks and tears not only the body, but the very heart and soul of every human being who once becomes a slave to it in any of its cruel and devastating forms. . . . Marihuana is a short cut to the insane asylum. Smoke marihuana cigarettes for a month and what was once your brain will be nothing but a storehouse of horrid specters. Hasheesh makes a murderer who kills for the love of killing out of the mildest mannered man who ever laughed at the idea that any habit could ever get him.16
He, more than any other figure, waged a vigorous, vicious, and racially charged campaign against marijuana. Propaganda around the country included statements like:
There are 100,000 total marijuana smokers in the United States, and most are Negroes, Hispanics, Filipinos and entertainers.17
Marijuana, a weird “jazz weed” frequently used by Mexican drug addicts, is the source of much crime in the Southwest.18
A reefer is a cigarette made of marijuana and marijuana is a narcotic weed introduced from Mexico to palliate the jittery nerves of hi-de-do Harlemites—especially, it seems, the nerves of bandsmen.19
Marijuana is taken by musicians. And I’m not speaking about good musicians, but the jazz type.20
Because there was no scientific or clinical evidence that cannabis was addictive or dangerous, and it did not, at the time, pose any major social problems, what was the motivation? What was it about cannabis that made it such a menace?
In 1931, du Pont started to manufacture neoprene, a synthetic rubber, and then began to work on a synthetic fiber that could replace silk. Nylon was eventually introduced to the market in 1935, and in 1938, du Pont received the patent.21 There are various theories on the motivation behind Anslinger’s frenzied attack on cannabis. Some believe it was driven by racial hatred, plain and simple. Others suspect that he was encouraged by Mellon to remove hemp as a possible competitor to du Pont’s new synthetic fiber. There is no proof of any orchestrated conspiracy, but Mellon was also the financier backing du Pont. And others have concluded that it was simply a career move to keep the bureau that so vigorously policed alcohol relevant and, most importantly, funded.
Newspapers continued to write articles characterizing Mexicans as frenzied, violent attackers, fueled by smoking marijuana. A 1935 Los Angeles Times article reported, “When a Mexican of the lower class runs amuck, tries to snip off the ears of his wife with the carving knife, cut the throat of his compadre, and it takes six to eight burly American policemen to get him to jail—when those things happen, I say it is as clear as day that the little chap, who otherwise, would be no stronger than a cat, has been smoking marihuana.”22
Marihuana Tax Act of 1937
In the 1937 congressional hearings, which would ultimately decide the fate of cannabis as a medicine, there was only one person who testified on its behalf. Dr. William Woodward, legislative counsel for the American Medical Association, began by stating that the word marijuana was not recognized by the medical profession, and most did not realize that it was indeed cannabis that was the substance in question. He also challenged the claims that cannabis caused addiction, insanity, violence, and death:
There is nothing in the medicinal use of Cannabis that has any relation to Cannabis addiction. I use the word “Cannabis” in preference to the word “marihuana,” because Cannabis is the correct term for describing the plant and its products. The term “marihuana” is a mongrel word that has crept into this country over the Mexican border and has no general meaning, except as it relates to the use of Cannabis preparations for smoking. It is not recognized in medicine, and I might say that it is hardly recognized even in the Treasury Department.23
He went on to explain that cannabis had largely fallen out of favor and was not overprescribed. As medicines like aspirin and morphine were introduced into the US Pharmacopeia, the uncertainties of dosing made prescribing cannabis less popular with the doctors of the era. While they still prescribed it, they were turning more and more to the convenient pills being made available:
I say the medicinal use of Cannabis has nothing to do with Cannabis or marihuana addiction. In all that you have heard here thus far, no mention has been made of any excessive use of the drug by any doctor or its excessive distribution by any pharmacist. And yet the burden of this bill is placed heavily on the doctors and pharmacists of the country; and I may say very heavily, most heavily, possibly of all, on the farmers of the country.
The medicinal use has greatly decreased. The drug is very seldom used. That is partially because of the uncertainty of the effects of the drug. That uncertainty has heretofore been attributed to variations in the potency of the preparations as coming from particular plants; the variations in the potency of the drug as coming from particular plants undoubtedly depends on variations in the ingredients of which the resin of the plant is made up.
To say, however, as has been proposed here, that the use of the drug should be prevented by a prohibitive tax, loses sight of the fact that future investigation may show that there are substantial medical uses for Cannabis.24
So what caused an ancient medicinal that was still used in other parts of the world, was added to the US Pharmacopeia in 1850, and was prescribed by Western physicians in England and the United States to be outlawed? Why was this medicinal, effective in treating seizures, chronic pain, melancholia, parasites, asthma, and menstrual cramps, stricken not only from the United States but also from virtually every country on the planet? It was probably not one single thing but a series of events and circumstances that led to the prohibition of cannabis.
While cannabis was found to be an effective treatment for many conditions, physicians and scientists did not know how or why it worked. One thing they did know was that dosing could be an issue. When prescribing the tinctures, it was not uncommon for a patient to experience adverse side effects like dizziness, altered mentation, nausea, vomiting, or excessive sedation. As we now know, the cannabinoid production varies from plant to plant, and ten drops of one batch might be therapeutic, but ten drops of the next batch might have a much higher content of THC and sicken the patient. With pills, doctors were able to prescribe the amount of medication, confident that the dose would not make the patient sick. Thus, the use of medicinal cannabis began to decline, not because it was ineffective or dangerous, but because medications in pill form were more predictable.
The LaGuardia Committee Report
In 1944, New York mayor Fiorello La Guardia consulted with the New York Academy of Medicine. He was well aware of the reports made public by Anslinger, Hearst, and others. What they described with cannabis did not match what he had heard about when serving in Congress. There, he learned of cannabis use by soldiers in Panama, which was described by the Army Board of Inquiry as relatively harmless. At the suggestion of the Academy of Medicine, La Guardia appointed a committee to conduct a social and scientific investigation of cannabis use. While La Guardia did not advocate cannabis use in excess, he hoped that the report might justify an amendment to existing federal law and that further research be done into the possible therapeutic value of cannabis in treating drug addiction.
The study documented that, under the influence of cannabis, subjects did not display statistically significant changes in behavior, the effects were not always related to the amount used, and that the effects at low doses tended to be opposite the effects at higher doses. It was also noted that subjects showed decreased motivation and objectivity, were less aggressive, and were more self-confident, which was thought to be a function of increased relaxation and disinhibition. It was noted that higher doses were associated with less-desirable effects, including anxiety, paranoia, and nausea. Most interestingly, the study compared the personality traits in chronic cannabis users with subjects who did not use cannabis:
When the productions of the undrugged marihuana user are studied, certain personality traits which serve to differentiate him from the non-user and from the “average” individual can be discerned. As a group the marihuana users studied here were either inhibited emotionally or turned in on themselves, making little response to stimuli in the world about them. People with this type of personality generally have difficulty adjusting to others and are not at ease in social situations. This withdrawal from social contacts apparently finds little compensatory or sublimating activity elsewhere. These subjects did not have a desire or urge to occupy themselves creatively in a manner that might prove socially useful. They showed a tendency to drift along in passive fashion and gave a good portion of their attention to relatively unimportant matters. These men were poorly adjusted, lonely and insecure. As indicated by their history they seldom achieved good heterosexual adjustment.25
This description brings to mind traits noted in patients with Asperger’s syndrome, which is a condition on the autism spectrum. It is characterized by impairment in social interaction; poor or nonexistent peer relationships; severe social anxiety; restricted patterns of behaviors; and intense interests in narrow, esoteric subjects. It is more common in males than females. As discussed in chapter 5, several preclinical studies have implicated defects in endocannabinoid signaling and neuroinflammation in the etiology of autism. I now think of self-medication, not aberrant behavior, when I encounter a patient with a history of early cannabis use.
The committee’s conclusions in 1944 contradicted the misinformation propagated in the campaign waged by Hearst and Anslinger. Further, marijuana was used mostly by minorities and was not a nidus for criminal behavior:
From the foregoing study the following conclusions are drawn:
• Marihuana is used extensively in the Borough of Manhattan but the problem is not as acute as it is reported to be in other sections of the United States.
• The introduction of marihuana into this area is recent as compared to other localities.
• The cost of marihuana is low and therefore within the purchasing power of most persons.
• The distribution and use of marihuana is centered in Harlem.
• The majority of marihuana smokers are Negroes and Latin Americans.
• The consensus among marihuana smokers is that the use of the drug creates a definite feeling of adequacy.
• The practice of smoking marihuana does not lead to addiction in the medical sense of the word.
• The sale and distribution of marihuana is not under the control of any single organized group.
• The use of marihuana does not lead to morphine or heroin or cocaine addiction and no effort is made to create a market for these narcotics by stimulating the practice of marihuana smoking.
• Marihuana is not the determining factor in the commission of major crimes.
• Marihuana smoking is not widespread among school children.
• Juvenile delinquency is not associated with the practice of smoking marihuana.
• The publicity concerning the catastrophic effects of marihuana smoking in New York City is unfounded.26
Single Convention on Narcotic Drugs
The Single Convention on Narcotic Drugs of 1961 is an international treaty between 154 nations to prohibit the production and supply of narcotics not licensed for medical treatment and research. Its purpose was to add synthetic opioids that had been developed since the Paris Convention of 1931, which controlled opium, morphine, heroin, coca, and cocaine. It was here that cannabis was added to the list of internationally controlled substances.27
Nixon’s War on Drugs
Under President Richard Nixon (1969–1974), Congress passed the Comprehensive Drug Abuse Prevention and Control Act of 1970, which regulates the manufacture, importation, possession, use, and distribution of certain substances.28 The Controlled Substances Act, Title II of the Comprehensive Drug Abuse Prevention and Control Act, puts drugs into one of five classifications. As schedule levels for medications go up, the theoretical risk of abuse goes down. Schedule I is defined as substances having a high potential for abuse, no accredited medical use, and a lack of accepted safety. Cannabis, or marijuana and any substance derived from its flower or leaves, is classified as Schedule I, as are heroin, LSD, MDMA (Ecstasy), mescaline, and peyote. Synthetic THC capsules, the exact same THC molecule found in the cannabis plant, were approved by the FDA and introduced to the market in 1986 as a Schedule II medication. Dronabinol was reclassified in 1999 to Schedule III.29
Just like Anslinger, Nixon waged a “war on drugs” based on what appears to be cultural and racial prejudice and misinformation. Dead set on instituting a policy that paid little attention to facts or science, Nixon requested a study that would support his conclusion that the use of marijuana was dangerous and should not be legalized. Former Pennsylvania governor Raymond P. Schafer headed the National Commission on Marihuana and Drug Abuse. Among its members were physicians, bipartisan representation from the US Senate and the House of Representatives, an attorney, a college president, a television producer, a university pharmacy department chairman, and a law school dean.
Instead of finding evidence to support continued prohibition, the commission found that marijuana users were not a threat to society but were, in fact, “timid, drowsy, and passive” and recommended in 1972 that marijuana should be decriminalized. Nixon ignored their findings. Instead, it was opposed in 1974 by the recommendations of a congressional subcommittee chaired by conservative Democrat Senator James Eastland from Mississippi.30
In 1994, Dan Baum, a writer for Harper’s Magazine, reportedly had a conversation with Nixon’s domestic policy adviser, John Ehrlichman:
You want to know what this was really all about? The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.31
The Obama-Era Enforcement Policies
The Cole Memo was written in 2013 by US Deputy Attorney General James M. Cole and sent to US attorneys. It stated that they should prioritize their focus on cannabis enforcement to distribution to minors and criminal and gang activity. They should also prevent diversion from legal to illegal states, authorized activity from being used as a front for trafficking, drugged driving, growing marijuana on public lands, and use and possession on federal property. Attorneys should refrain from prosecuting state-approved cannabis businesses as long as they comply with their state’s cannabis regulations.32
As part of the 2014 Farm Bill, legislation was passed legalizing cannabis sativa L., the fiber or industrial-type plant with less than 0.3 percent THC. State-licensed growers are allowed to grow, process, and sell products from this plant as part of a state’s sanctioned research program. It is through these state programs that online and retail hemp-derived cannabidiol (CBD) products are produced.33
Rohrabacher-Blumenauer Amendment
The Rohrabacher-Blumenauer Amendment (also the Rohrabacher-Farr Amendment), first introduced in 2001 by Dana Rohrabacher (R-CA), Maurice Hinchey (D-NY), and Sam Farr (D-CA), forbids the Justice Department from using federal funds to interfere with a state’s medical cannabis program. It passed in 2014, after six prior failed attempts as part of an omnibus spending bill. Currently the amendment has to be renewed with each new budget bill.34
Attorney General Sessions
In the spring of 2017, former senator and newly appointed attorney general Jefferson Sessions (R-MS) wrote a letter to Congress requesting a repeal of the Rohrabacher-Blumenauer Amendment:
[It would] inhibit [the Justice Department’s] authority to enforce the Controlled Substances Act. I believe it would be unwise for Congress to restrict the discretion of the Department to fund particular prosecutions, particularly in the midst of an historic drug epidemic and potentially long-term uptick in violent crime. The Department must be in a position to use all laws available to combat the transnational drug organizations and dangerous drug traffickers who threaten American lives.35
In response to the Sessions letter, Senators Cory Booker (D-NJ), Kristen Gillibrand (D-NY), Mike Lee (R-UT), and Rand Paul (R-KY) reintroduced the CARERS Act, which initially stalled after being introduced in 2015.36 This bipartisan act would allow the possession, production, and distribution of medical marijuana in states that have legalized it. It would also allow Veterans Administration doctors to recommend it to their patients in those states where it is legal; improve access to cannabis for medical research; and deschedule CBD, the major nonpsychoactive component of the plant.37
On January 4, 2018, the attorney general rescinded the Cole Memo.38 This, according to some, has opened the door to federal policing in states that (1) have medical cannabis programs, where a patient must have a doctor’s recommendation to use cannabis legally; (2) have decriminalized cannabis use (it is illegal, but if caught, offenders may have to pay a fine on par with running a red light); and (3) have legalized adult-use recreational cannabis for anyone over the age of 21. As for now, the Rohrabacher-Blumenauer Amendment protects medical cannabis programs that are run in compliance with state regulations but not recreational or adult use. While there are concerns about federal interference from officials and cannabis business owners in states with legalized recreational cannabis and users in states that have decriminalized cannabis use, many believe this move by the Justice Department will serve as motivation for states without formal programs in place to increase their efforts to pass medical cannabis legislation.
Summary
The current historic drug epidemic has nothing to do with cannabis. The rise in drug-related deaths is caused by increased access to opiates and benzodiazepines, the combination that accounts for the majority of prescription drug overdoses—access that begins in the doctor’s office when patients are prescribed these medications for chronic pain. For some, their pain has resolved, and the drugs remain in the medicine cabinet for other family members to access; for others, it marks the beginning of addiction. A 2014 study published in the Journal of the American Medical Association showed that opiate-related overdose death rates had declined by as much as 24.8 percent in states with legal medical cannabis.39
After the 2014 legalization of small amounts of cannabis for recreational use in Colorado, violent crime rates in Denver fell 6.9 percent in the first quarter of 2014 compared to the prior year, and property crime dropped by 11.1 percent. A study published in 2014 by researchers at the University of Texas at Dallas concluded that legalization of cannabis does not correlate with an increase in violent or property crime and may actually reduce it as well as reduce alcohol consumption, which is associated with an increase in violent crime. Since the legalization of medical cannabis, marijuana trafficking by Mexican drug cartels has decreased significantly, just as bootlegging disappeared after the end of alcohol prohibition.40
It is important for patients and health-care providers to understand that the reasons for cannabis being made illegal were based on, what some would argue, economic and sociopolitical issues, not science and medicine. The energy spent on making and keeping it an illegal, schedule I substance is grossly disproportionate to the adverse effects attributed to the plant.
As of June 2017, cannabis is legal for medical use in 29 states, the District of Columbia, and 2 US territories: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, the District of Columbia, Guam, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Vermont, and Washington. An additional 17 states have restrictive CBD-only laws in effect: Alabama, Georgia, Indiana, Iowa, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. Only in two of these, Alabama and Missouri, is it possible to obtain CBD without breaking state or federal law. Nebraska is an industrial hemp state, and residents are allowed to use hemp-derived CBD, but Kansas and Idaho are not, so those residents have no legal access at the state level to cannabis of any kind.
Cannabis is no longer considered a gateway drug. According to the CDC, persons addicted to alcohol are two times more likely to also be addicted to heroin, while those addicted to marijuana are three times more likely. In contrast, individuals addicted to cocaine are 15 times more likely to be addicted to heroin, and those addicted to prescription drugs are 40 times more likely to have a heroin addiction.41 Alcohol, cocaine (commonly used by ENT and plastic surgeons to control bleeding in the operating room), and obviously prescription drugs are all legal.
Cannabis has anti-inflammatory, analgesic, anxiolytic, antipsychotic, antitumor, antispasmodic, and antidepressant effects. It has been proven effective in treating seizures and neuropathic pain in double-blind, placebo-controlled, multicenter studies, where they can research the effects on large numbers of patients, and neither the patient nor the researcher knows who is being treated with cannabis, in order to remove any bias or preconceptions of the part of patients and researchers. It has a relatively low potential for addiction (6 to 9 percent versus 13 to 18 percent for alcohol). Unlike alcohol, cannabis has a lethal dose so high that it’s impossible for a person to inhale or ingest it, and it has no known long-term health consequences other than possible effects on memory and cognition in heavy users who start at a young age.
One has to ask, Why is this plant schedule I? It is my hope that, as you read about the many benefits of cannabis and its remarkably low toxicity profile and learn how to use it in a manner that is not impairing, you might consider it as a safe and effective alternative or addition to your therapeutic program to achieve better health and well-being.
Chapter 9
Making Your Own Medicine
The plant was named Cannabis sativa by Carl Linnaeus in 1753 and is known to be extremely hardy. It commonly grows abundantly as a weed in any area that is well watered, like drainage ditches. It is an environmental cleaner, meaning that it sucks up pesticides, contaminants, and heavy metals from the soil. It also uses up nutrients in the soil and will crowd out other vegetation if left to its own devices.
The cannabinoids, flavonoids, and terpenes are the medicine in cannabis and are produced in tiny hair-like projections called trichomes, which are found mainly in the flower and to a much lesser extent on the stems and leaves. It’s within these glandular structures where the resin is produced. In addition to producing the plant’s medicinal compounds, this sticky substance prevents the plant from losing water.
Cannabis is dioecious, meaning that there are distinctly male and female plants. It was once thought that only the females produced the resin, but it is now known that both sexes produce resin, but the female plant produces much more than the male.
Growing Your Own
I am not a big fan of homegrown medicine and don’t encourage patients to grow their own. With a practice full of patients at risk of developing serious infections—children, the elderly, cancer patients on chemotherapy, and patients on immunosuppressive drugs, I want to know that there are no pathogens—bacteria, mold, or toxins—contaminating the plant that can be deadly to patients who are unable to fight off infections. Cannabis grown in facilities that are highly controlled are less likely to have contaminants that might be harmful, especially if inhaled. Many medical cannabis states have instituted mandatory testing by independent laboratories to ensure that the products are safe for use.
Another reason for promoting dispensary medicine is that, unless the patient has their product tested for cannabinoid and terpene profiles, we don’t know what it is about that cultivar that is helping or not helping. Even knowing what the plant is supposed to be does not translate into what you actually get. There are so many things that affect the cannabinoid and terpene content. The amount of UV light, temperature, soil pH, what’s in the water, whether the leaves are picked from the top or bottom—all translate into varying concentrations of cannabinoids.
Collectives
In states where growing your own cannabis is allowed, there may be collectives or growing clubs that can help a patient grow small batches of up to five or six plants, depending on the number of plants the state allows the patient to grow. They can assist by helping a patient create a clean and healthy environment in the home for growing and often have access to an accredited lab for testing the end product. This may be the ideal solution for patients who enjoy horticulture and need a more economical source for quality medicine. With some collectives, each patient grows a small amount, so if there is a problem with mold or bacteria, there are only a few plants that have to be discarded. The harvests are tested and then shared among the participants.
Cultivation
Cannabis can be grown indoors or outdoors and in soil or in solutions. Hydroponics is a method of growing plants in mineral nutrient solutions without soil. It is not an easy undertaking, and you have to know which cultivars to grow and which nutrients to use and use the correct water-nutrient solution. If the right nutrients are used, these plants tend to be healthier and produce more medicine.
When it comes to advice on cultivating, though, Eric Jones, chief grower at Holistic Industries, recommends the following:
1. Keep it simple. You don’t need an expensive setup to grow high-quality medicine.
2. Research strains online at sites like www.Leafly.com. Find cultivars that meet your needs, and order seeds from a reputable seed bank. Avoid growing from cloned plants, as they may harbor pests and diseases.
3. Grow in organic potting mix in an area indoors where you can control the lighting 24 hours a day or outdoors from late spring to fall. A commercial growing tent can be used indoors if you do not have a suitable location.
4. Only use organic soil amendments and pesticides. Do not use systemic pesticides—pesticides that do not remain on the surface but are absorbed by the plant. Read the labels thoroughly, and only use through the first four weeks of the flower cycle or up to the day of harvest if approved by the manufacturer for edible crops.
5. Keep things clean and sterile. Wash all equipment and the growing space, if indoors, regularly.
6. Purchase a guide, such as Indoor Marijuana Horticulture: The Indoor Bible by Jorge Cervantes.
7. Hydroponic shop employees can provide great advice, but don’t let them sell you on “miracle” products.
8. Rinse your plants with plain water and allow them to dry prior to harvest. This will help remove dust and residual contact pesticides.
9. Dry the final flower and leaf product completely over a week to avoid postharvest fungi.
Dry flower and leaves can be smoked or vaporized, or they can be processed into a tincture for sublingual administration. Tinctures are typically alcohol based but can be made into oils, which are easier to administer because they can go directly under the tongue without discomfort. Leaves and stems can be used to make topical salves.
Making Tinctures
Tinctures are relatively easy to make and easy to dose if you know the concentration of delta-9 THC and CBD in your plant material. For THC and CBD tinctures, you must decarboxylate your flower by baking it first. For THCA and CBDA tinctures, skip the baking. There are many opinions regarding the optimal temperature and time for maximum decarboxylation, and I invite you to do your research and experiment. If you live in an area that offers laboratory testing, by all means, do your calculations, but confirm by spending a little extra money to have your tincture tested for its cannabinoid content. If testing for cannabinoids is available, you can gain some really valuable information. Set aside a time when you are not rushed, and prepare a clean work surface, like your kitchen counter or table. You need some basic equipment:
• Scale
• Pyrex dish
• Aluminum foil
• Blender, food processor, coffee grinder, or cannabis grinder
• Beaker or glass bowl with spout
• Funnel
• Strainer
• Cheesecloth or coffee filter
• Jar or Erlenmeyer flask
• Magnetic stirrer or Sonicator for speeding up the process (optional)
• Water distiller (optional)
• Amber or blue tincture bottles with eyedropper tops
• Everclear grain alcohol
• MCT or organic olive oil
1. Weigh your flower. It is more economical to use shake (broken pieces of flower, not the intact bud). If you are using dispensary medicine, then you can skip this step, as the weight is on the package.
2. Do your calculations. Multiply the weight of the flower by the concentration of cannabinoid. For example, if you have 10 grams of flower that is 15 percent CBD and 18 percent THC, then multiply:
10g × 0.15 = 1.5 g × 1,000 = 1,500 mg CBD
10g × 0.18 = 1.8 g × 1,000 = 1,800 mg THC
You lose approximately 20 percent during the process, so you must multiply your totals by 0.8:
1,500 mg × 0.8 = 1,200 mg CBD
1,800 mg × 0.8 = 1,440 mg THC
3. Place the flower in a single layer in a rimmed cookie sheet or Pyrex dish, cover with foil, and heat at 240 degrees F for 45 to 60 minutes, or 250 degrees F for 25 minutes, stirring every 10 minutes to ensure even heating. This converts, or decarboxylates, the THCA to THC. Keep covered and allow to cool completely. The flower should be dry and crumbly, not scorched or crispy.
4. Once the flower is cool, grind it to increase the surface area that comes into contact with your solvent. Don’t overgrind. You don’t need powder.
5. Place the ground flower into a beaker or glass bowl and add grain alcohol, enough to cover the flower completely.
6. Place in a Sonicator or magnetic stirring plate. If using a magnetic stirrer, you must place a magnet in the beaker as well. Turn it on for 15 to 20 minutes, until the solution is dark green. (If you do not have this type of equipment, then you can place the flower and alcohol in a jar and shake a couple of times a day for 7 to 14 days.)
7. Strain the liquid through a kitchen sieve to remove the larger plant material; then strain again through a funnel lined with either cheesecloth or a coffee filter to remove the finer sediment and particles.
8. At this stage, you have an alcohol tincture that you can use for medicine. If you plan to take your medicine under the tongue, then you don’t want to use an alcohol tincture because it is very harsh and stings. Oil is also preferred for tinctures for children. Some patients are very sensitive to alcohol and want to avoid even these very small doses.
To make an oil-based tincture, pour your liquid into a water distiller to extract the alcohol. This leaves a gummy substance that contains all of the cannabinoids and terpenes. Transfer the substance to a clean jar. Add organic olive oil or MCT oil to complete the process, and mix thoroughly.
For making a THCA and CBDA tincture, you want to skip the baking and the water distiller. The distiller gets hot and may convert some of your acid cannabinoids into THC and CBD. Instead, pour the liquid onto a flat pan, and allow the alcohol to evaporate. Placing a fan nearby speeds up the process. When the alcohol has evaporated, scrape the resin from the pan, gradually adding your oil to loosen it. Once it’s a consistency that can be scooped or poured, transfer it to a measuring cup or beaker and add your MCT oil or olive oil; then pour it into an amber or cobalt blue tincture bottle, and store in a dark, cool place.
Next, you have to decide how concentrated you want your tincture to be. Take the total number of milligrams and divide by the number of milligrams you want per milliliter. For example, if your batch contains 1,440 milligrams of THC and you want your tincture to have 10 milligrams per milliliter, then your calculation would look like this: 1,440 mg ÷ 10 mg/mL = 144 mL. If you want your tincture to have 5 milligrams per milliliter, then add 288 milliliters of oil. If you have 1,200 milligrams of cannabinoid and want to make a tincture with 10 milligrams per milliliter, then add 120 milliliters of oil.
While I am not an expert at making tinctures, I have made THCA and CBDA tinctures because they are generally not available in my geographical location. Using the methods here results in concentrations of THCA and CBDA that have been remarkably close to my calculations. If, however, this is too labor intensive, then try making tinctures with an herbal infuser, like the Magical Butter Machine or Mighty Fast Herbal Infuser, sold online and in many dispensaries. These machines can be purchased for around $175.
Making Edibles
Edibles are difficult to dose because of their unpredictable absorption, and they are easy to overdose on because patients often think they haven’t taken enough. They can be useful for patients with pain that does not respond to other forms of cannabis because the pain-relieving effect is increased. Care must be taken with edibles because the intoxicating effect of the THC is also enhanced. Ingestion increases the pain-relieving effects by converting delta-9 THC to 11-OH-THC. This compound not only has superior pain-relieving effects, but it is also more intoxicating than delta-9 THC, which does not make it practical for daytime use in patients who are working, in school, or driving.
For patients who wake up frequently in the night, edibles can be helpful because the effect lasts longer than any other mode of delivery: 8 to 10 hours and sometimes longer. If you are in need of increased pain relief or prolonged effectiveness, chocolates are a good choice. The chocolate lingers in the mouth for a while, so some medicine is absorbed there. Also, the fat in chocolate will increase the absorption in the intestines.
Melt chocolate chips and thoroughly mix in your concentrate. Pour the mixture into a shallow pan or mold and score into the appropriate number of pieces. If you have 500 milligrams of THC and want each chocolate serving to have 5 milligrams, then you will have 100 pieces. Even with thorough mixing, chances are the medicine will not be evenly distributed, so you will run the risk of having a chocolate that has more or less than the dose you want.
Cannabis/Turmeric Latte
This is a recipe for a creamy, savory, yet sweet latte made with inflammation-fighting cannabis, turmeric, coconut milk, almond milk, and MCT oil. This is very simplified version of a traditional Bhang Lassi drink served in India and Nepal during Hindu festivals like Holi, Janmashtami, and Shivratri. The original recipe calls for yogurt, nuts, spices, and rosewater. The fat in the recipe increases the absorption of the cannabinoids, and fat and black pepper (piperine) enhance the bioavailability of curcumin, the active anti-inflammatory compound in turmeric. It’s best to sip these concoctions slowly so that you are relaxed and not overwhelmed by too much of an intoxicating effect.
Native to southern Asia, turmeric is a relative of the ginger plant. It has also been used for thousands of years in Ayurvedic medicine. Studies show that turmeric contains compounds that block the formation of amyloid proteins, the hallmark of Alzheimer’s disease, and dozens of anti-inflammatory compounds, including curcumin. It has been shown in animal studies to be effective in treating certain cancers. Many of my patients with chronic pain experience relief with this simple concoction. Organic, fresh-ground turmeric is best. If adding cannabis, use a variety with a CBD:THC ratio of 1:1 for daytime pain relief. If pain is persistent, try increasing the THC gradually. For insomnia or nighttime pain, sip a THC-rich variety high in myrcene an hour before bedtime for a restful, restorative, pain-free night. For patients in nonlegal states, follow this recipe without the cannabis oil or, if allowed in your state, with hemp-derived CBD.
2.5–10 mg cannabis concentrate (for cannabis-naïve patients, start with 2.5 mg; you can gradually increase the potency by 2.5-mg increments until it is effective in relieving your pain, muscle spasm, or insomnia)
1 T MCT oil
½ c. full-fat canned coconut milk (or you can use 1 T grass-fed butter or ghee if you eat dairy)
c. almond milk
½ t ground turmeric
½ t vanilla extract
1 T honey
Pinch of sea salt
Pinch of ground cinnamon
Pinch of black pepper
Add all ingredients to a small saucepan. Stir and simmer over low heat for about two minutes. Pour into your favorite mug, and sip slowly.
Cannabis Milk
Use a cannabis variety with a CBD:THC ratio of 1:1 for daytime pain relief. If pain is persistent, try increasing the THC gradually. For insomnia or nighttime pain, use a THC-rich variety high in myrcene an hour before bedtime for a restful, restorative, pain-free night.
1g of ground cannabis flower CBD:THC ratio 1:1
2c. prepared or homemade almond milk (or coconut milk or whole grass-fed milk)
⅔ t coconut oil (or grass-fed butter)
Pinch of nutmeg or cinnamon
Honey to taste
Stir occasionally over low heat.
Acknowledgments
I would like to say thank you to:
Mark, Ashleigh, and Chris, for introducing me to the world of medical cannabis;
My agent, Diane, for bringing me this remarkable opportunity;
My husband, Rodney, who has given me the encouragement to stay on the path, the time and space to get it done, and the meals to keep me going;
My son, Andrew, just because you are my shining star;
Tamika and Anne Marie, for everything you do to keep our office running and making our patients feel as important as they are;
Lisa, Taryn, and Heidi, for your help with research, edits, and citations;
Dave, for your guidance and everything you have done to make this work;
Suzanne, my editor, for her constructive criticism and commitment to the subject of medical cannabis;
Adam, Eric, and Franco, for sharing your knowledge and expertise;
Doctors Dustin Sulak, Bonnie Goldstein, Deborah Malka, John McPartland, David Bearman, Jeff Hergenrather, Debra Kimless, and all the cannabis clinicians who have inspired me and define what excellent patient care is all about;
And all of my amazing patients, from whom I have learned so very much about true art of healing.
Introduction
In 1996, California became the first state in the United States to legalize cannabis for medical use. I was practicing pediatrics at a large health maintenance organization in the southern part of the state. There was probably something about it in the news. I think that was the extent of my awareness. I never gave it another thought—until 2015.
Now back on the East Coast and still holding onto my coveted California medical license, I decided to look for some light, part-time telemedicine work. I took my license out of retirement mode and farmed out my curriculum vitae. The first solicitation I received was regarding a pediatric job in San Diego. I explained to the headhunter that I was licensed in California but physically in the Washington, DC, metropolitan area and was not interested in relocating. I would only consider a telemedicine job, perhaps an urgent-care or after-care position.
A few days later, I received another e-mail. It emphatically reassured me that this was a telemedicine job with a new company based in San Francisco. Great, I am interested and excited! As I am reading, looking for the particulars, it goes on to state that the job is to evaluate patients via telemedicine for medical marijuana evaluations. Skreech! What? Marijuana? I don’t know anything about marijuana. I tried it a few times in high school and twice as a freshman in college. It made me either goofy, sleepy, or paranoid, so I never thought much of it. I certainly never understood why my peers liked it so much.
So here I am faced with an opportunity to work a few hours a week from my home office with patients in California, and I knew nothing about the plant, how it worked, what it was good for, the possible side effects, or how it was dosed; I knew nothing.
Not being one to run from a challenge, I decided to investigate. I interviewed with the president and director of operations. They were clean cut, well spoken, friendly, organized, and professional—not the sleepy-eyed, counterculture stereotypes one might imagine. It was a brand-new company, and except for their chief medical officer, I was their first medical hire.
I spent the next few days reading the California Board of Medicine’s guidelines on what conditions qualified and their assurances that I would not get into trouble making these recommendations—via telemedicine, no less. I started to review the illnesses and conditions that were on their list and began a Pubmed search on cannabis and its role in alleviating the symptoms associated with these conditions. (Pubmed is an online database of journal articles from the National Institute of Health Library.) I searched for marijuana, and lo and behold, there were more than 34,000 articles on the subject; cannabinoids yielded more than 10,000; and endocannabinoid turned up more than 11,000!
I started reading and eventually enrolled in an online course on medical cannabis. I attended whatever conferences I could. Armed with a cheat sheet and a strong internet connection, I began my journey into the field of cannabis medicine. Over the course of the year, I evaluated approximately 3,000 patients. My California patients came from all walks of life and all ages. There were college professors, truck drivers, professional chefs, software developers, doctors, computer programmers, housewives, actors, small business owners, attorneys, students, and retired grandparents. They shared with me the reasons they used cannabis, how they used it, when they used it, and how much.
I learned about applying salves topically to ease migraine or arthritis pain and how to steep cannabis tea or milk to sip through the day to improve its pain-relieving effects. Cancer patients with inoperable tumors that had resolved with cannabis use shared their stories. Anxiety patients would carry a vape pen that they could use in case of a panic attack. Patients with sleep problems were getting the best sleep ever by taking a few drops of cannabis oil at bedtime. And one of the most important things I learned from my patients was how they used cannabis without getting stoned. They could treat their symptoms with no mental impairment. I didn’t know that was possible. It was an invaluable education.
We know that there may be long-term consequences for recreational users or patients who self-medicate or who use high doses of cannabis over an extended period of time. But these were patients who were using low to moderate doses of cannabis over many years and who were motivated, functioning successfully, and benefiting from its pain-relieving, muscle-relaxing, antianxiety, and mood-stabilizing benefits. There were patients who, much to many people’s surprise, had cancers that were no longer detectable and pain patients who were no longer on opiate medication and were managing their pain with just medical cannabis. At the end of that year, I thought to myself, “This plant is pretty amazing. And more people, patients, and health-care providers should know about it.” It was then that I decided to call the plant by its scientific name and to drop the term marijuana, which had been used to stimulate fear and racial bigotry in an effort to make it illegal for financial and political reasons.
There are a lot of books on the market about cannabis—the science and the medicine. Some are geared more for the doctors and scientists, some for patients or consumers, and some for the horticulturalists and processors. There is even more on the internet, much of it geared toward people who use it for THC’s intoxicating effects, but some sites with a more medical focus. There is some very sound information—and other information, not so much. When researching cannabis, it is important to remember that most people who blog or comment about cannabis can only speak for how it affects them. They don’t have the experience of evaluating thousands of people, so their perspective is limited and may not pertain to you and how your body may respond.
Around the world, there has been a resurgence in the use of traditional herbal medicines. In Japan and Taiwan, Kampo, a Japanese variation of traditional Chinese medicine, is fully integrated into the health-care system. By 2010, approximately half of the medical doctors in Japan were incorporating herbal medicine into their practice. More than 70 percent of German physicians prescribe herbs. People are looking for safer and more natural approaches to health and well-being, and cannabis is at the forefront of that movement.
Cannabis has been used medicinally for 5,000 years. It has been an illegal substance for only 75 years. Are there risks to using cannabis? A few, but none that are life threatening. The reasons to make it and keep it illegal at the federal level are not based on science or medicine. There are sociopolitical factors that have kept this very complicated and mostly beneficial plant in the juke joints, back alleys, rock concerts, and college dorms.
This book is written for the patient who has never considered using medical cannabis as a treatment alternative and for the health-care provider who has never considered discussing medical cannabis with their patients. It is my hope that, after reading this book, providers (even those who are not able to make official recommendations for their patients) and patients who would otherwise not even think about the use of medical cannabis will be more comfortable having the discussion and making an informed decision on whether cannabis might help them. If you decide that cannabis might be worth a try, read, ask questions, start low, and go slow, as you explore the healing properties of this ancient, medicinal plant.
Index
11-Hydroxy-tetrahydrocannabinol (11-OH-THC), 139, 148
5-alpha-reductase inhibitor, 47
absorption, 69, 99, 104, 132, 134, 135, 140, 141, 148, 158
abuse, 12, 18, 96, 114, 117, 118, 166, 167, 186, 187,
acetaminophen, 60, 61
acholasia. See esphageal spasm
acne, 76, 138
acupuncture, 2, 157, 159, 189, 195
addiction, 5, 8–11, 14, 15, 59, 60, 67, 116–118, 169, 170, 187, 192, 197
addiction, potential, for 116–118, 169, 187
Addison’s disease, 70
adolescents, 97, 98, 112–114, 116, 119, 186–188, 202, 211
adrenal glsand, 81, 93, 94, 100, 184, 200
adverse effect, depression, 151
adverse effect, dysphoria, 49, 111
adverse effects, ix, 103–119
adverse effects, addiction, 116–118, 187, 202, 211
adverse effects, anxiety, 5, 10, 44, 50, 57, 88, 104, 106, 141
adverse effects, cognition, 15, 111, 137, 138, 187
adverse effects, paranoia, 5, 10, 44, 88, 104, 106, 138, 139
adverse effects, cardiac, 100, 101, 107
adverse effects, memory, 3, 4, 15, 87, 91, 101, 104, 105, 110–113, 119, 138
aflatoxins, 52, 177, 205
aggression, aggressive behavior, 22, 69, 98, 99
AIDS, 18, 49, 51, 55, 108, 173
AIDS, qualifying condition, 20–29, 31, 33
Alabama, 15, 30, 59, 171
Alaska, 15, 19, 20
alcohol, 5–8, 14, 15, 51, 52, 56, 96, 97, 103, 105
allodynia, 61, 63
alpha caryophyllene, 45
alprazolam, 61, 62, 89, 115, 161
Alzheimer’s disease, 20, 22–29, 31, 33, 82, 86, 87, 148, 155, 182, 194, 201, 206, 208
American Academy of Pediatrics (AAP), 97, 98, 112, 186, 195
American Medical Association (AMA), 14, 152, 167, 189, 193
amitriptyline, 61, 62, 161, 163, 164
Amotivational syndrome, 119
amyotrophic lateral sclerosis (ALS), 86, 87
amyotrophic lateral sclerosis (ALS), qualifying condition, 22–31, 33
animal protein, 158
animal studies, 18, 41, 43, 45–48, 67, 74, 78, 83, 87, 89, 91, 92, 94, 148, 151, 155, 157, 173, 194
Anslinger, Harry, J, 7, 8, 10–12, 166, 191
anti-Mexican campaign, 6, 7, 8
antianxiety, x, 3, 15, 44, 46, 47, 57, 58, 62, 63, 73, 75, 78, 80, 81, 85, 86, 88–92, 95–97, 106, 139, 151, 182
anticonvulsants, 42–44, 46, 50, 60, 61, 90
antidepressant, 15, 43, 47, 48, 62, 63, 71, 73, 75, 78, 89, 90, 96, 151, 188
antifungal, 46, 47, 79, 104
anti-inflammatory, 15, 42–47, 60, 61, 64, 71, 74, 76, 77, 84, 85, 87, 108, 136, 148, 151, 180, 193, 196
antitumor activity, 15, 43–48, 108, 151, 202
antiviral, 46, 48, 79
anxiety, x, 19, 29, 30, 44, 57, 60, 61, 66, 68, 70, 71, 77, 81, 88–90, 95, 97–99, 101, 113, 153, 155, 156, 178, 182, 207
apigenin, 47, 48, 176
appetite, 18, 40, 41, 43, 44, 49, 50, 70, 73, 75, 77, 80, 87, 88, 93, 95, 99, 104, 107, 139, 151, 155, 156, 180, 195
appetite, qualifying condition, 21, 24, 27, 29
arachidonic acid, 41, 151, 155
Argentina, 17, 168, 192
Arizona, 15, 20, 109, 152
Arkansas, 6, 15, 20, 59
aroma, 3, 45, 46, 131
arsenic, 4, 53
arthritis, x, 63, 70, 79, 131, 156
arthritis, qualifying condition, 22–24, 27, 29, 30, 33
Aspergillus, 52
asthma
Australia, 17, 18, 50, 109
Austria, 50, 70, 169, 197
Autistic Spectrum Disorder (ASD), 10, 22, 28, 30, 58, 68–70, 77, 81, 98–100, 125, 155, 178, 179, 194–196, 198, 211
autoimmune disease, 23, 27, 30, 44, 63, 70–73, 79, 100, 108, 151, 155
autoimmune disease, 30, 44, 70–73, 79, 100, 108, 151, 155
Ayurveda, 4, 95, 138, 165
B-sitosterol, 47
bacterial contamination, 51
balance, impaired, 85, 86, 101, 104, 105, 111, 119
Belgium, 17, 50, 169, 197
Belize, 17, 169, 210
Benet, Sula, 3
beta-caryophyllene. See terpenes
bhang, 4, 148
bioavailability, 135, 140, 148, 158
biofeedback, 159
Biphasic effect, 96, 105, 130–131
bipolar disorder, 89, 90, 116, 183
blood-brain barrier, 42, 132
Blumenauer (D-OR), 13, 14, 36
brain fog, 70, 71
brain, developing, 114, 189, 194, 209–211
brain, hypoxia, 82, 83, 181
Brazil, 17, 50, 88, 169, 210
breastfeeding, 89, 109
bursitis, 63, 64
Bush, George W., 18, 19
butane, 52, 55, 133
C. indica, 4, 6, 41, 127, 128, 188, 206
C. ruderalis, 41
C. sativa, 5, 13, 41, 127, 128, 143, 152, 153, 175, 179, 180, 188, 191, 192, 203, 205, 207, 209
cadmium, 53
California, ix, x, 6, 15, 17, 18, 21, 51–56, 69, 100, 108, 117, 123, 124, 129, 152
cancer, x, 17, 43, 47, 49, 50, 63, 68, 73–76, 135, 140, 143, 148, 156, 165, 174–176, 179, 180, 184, 194, 195, 199, 202, 204, 208
cancer cervical, 75, 203
cancer melanoma, 48, 75
cancer, breast, 46, 75, 209
cancer, glioma, 75, 193
cancer, liver, 52, 75, 177, 205
cancer, lung, 48, 74–76, 108, 136, 188, 193
cancer, melanoma, 75, 179
cancer, pancreas, 48, 74, 75, 176, 179
cancer, prostate, 42, 75
cancer, qualifying condition, 20, 22–33
cancer, testicular, 110, 186, 201
cancer, thyroid, 75
cancer, colorectal, 46, 75
Cannabaceae, 41
cannabinoids, x, 18, 39–45, 52–53, 64, 74, 76, 79, 83, 84, 87, 90, 104, 110, 127, 128, 132–137, 140, 143–145, 147, 148, 153, 155, 161, 173–175, 178–185, 187, 191–199, 201–209
cannabinoids tetrahydrocannabinol (THC), 1, 5, 9, 12, 13, 17, 18, 30–35, 41–46, 48–50, 52, 53, 56, 57, 63–77, 79–97, 99–101, 103–107, 109–117, 119, 121, 125, 127, 128, 130, 134, 135, 137–141, 145–149, 151–153, 162–164, 175, 179, 185–187, 194, 200, 201, 207
cannabinoids tetrahydrocannabinolic acid (THCA), 18, 34, 42, 52, 71, 72, 74, 76, 99, 137, 145–1147
cannabinoids, acids, 18, 42, 43, 76, 137, 147
cannabinoids, cannabichromene (CBC), 42–44, 52, 79, 137
cannabinoids, cannabichromenolic acid (CBCA), 42, 43
cannabinoids, cannabidiol (CBD), 13, 14, 15, 17, 18, 30–36, 41–44, 49, 50, 52, 53, 57, 63–77, 79–90, 92, 94–101, 104–107, 109, 111, 112, 115, 116, 119, 128, 130, 134, 135, 137, 138, 140, 141, 145–147, 149, 151–153, 161, 163, 164
cannabinoids, cannabidiolic acid (CBDA), 157, 188, 207, 209
cannabinoids, cannabidiovirdin (CBDV), 41, 42, 44, 45, 52
cannabinoids, cannabigerol (CBG), 42, 44, 52, 53, 79
cannabinoids, cannabigerolic acid (CBGA), 42, 52
cannabinoids, cannabinol (CBN), 42, 43, 45, 48, 52, 53, 79, 107, 130
cannabinoids, synthetic (illegal), 48–49
cannabinoids, synthetic (pharmaceutical), 49–50, 67, 75, 194
cannabis use disorder, 112, 116–117, 124
cannabis, history of, 1–5
Canon of Medicine, 3
capsaicin, 188
cardiac disease, 43, 94, 100, 107, 184, 188, 208
cardioprotection, 94, 155, 184, 198, 200
CARERS Act, 36
carrier proteins, 41
CB1. See receptors
CB2. See receptors
CBD-only states, 30–34
central nervous system, 26, 40, 41, 82–88, 194
cerebellum, 101, 131
cerebral vascular accident. See stroke
cervical stenosis, 63
Cesamet. See nabilone
chemotherapy, 17, 45, 49–51, 55, 60, 73, 75, 139, 143
children. See pediatric use
Chile, 17, 50, 168, 206
Chinese medicine, xi, 2
Chlamydia pneumoniae, 47, 176
cholera, 4, 180
chronic obstructive pulmonary disease (COPD), 108, 136
chronic traumatic encephalopathy (CTE). See traumatic brain injury
Clean Green Certified, 54, 55
clinical conditions, 57–102
Clinton, Bill, 18
cocaine, 5, 6, 11, 15, 97, 118, 119, 161
cognition, improvement, 88, 92
cognitive behavioral therapy, 159
Cole Memo, 12, 14
colitis, 70, 71, 140
colitis, qualifying condition. See ulcerative colitis
Colombia, 17, 50, 168, 169, 192
Colorado, 14, 15, 21, 53, 54, 105, 112, 128, 152, 177, 185, 186
complex regional pain syndrome (CRPS), 63
Conant v. Walters, 19
concentrate(s), 25, 34, 52, 56, 133, 137
Connecticut, 15, 21, 152, 170
connective tissue disease, 30, 63, 70
contaminants, 51–56, 65, 99, 108, 133, 143–145, 152, 177, 203, 206
contraindications, cardiac, 100
contraindications, hyperemesis syndrome, 119
contraindications, nursing, 109
contraindications, pregnancy, 109
coordination, 101, 105, 111, 112, 114, 119
Costa Rica, 17
COX–2 inhibitor, 43, 47, 151, 162–164
Croatia, 17, 168, 202
Crohn’s disease, 20, 21, 23–31, 33, 79, 80, 97, 98, 138, 180, 204,
cultivation, 1, 33, 34, 52, 55, 144–145, 152, 153, 165, 169, 195
cyanide, 53
cyclobenzaprine, 61, 62, 111, 115
cytochrome P450, 101, 114, 185, 187, 189
cytokines, 40, 62, 79, 177
Czech Republic, 17, 50, 169
dabbing, 137, 138
death rates, opioids, 14, 59, 200
decarboxylation, 43, 145, 146
decorticator, 62, 63, 73, 131,
decriminalized, countries, 17, 18
Delaware, 15, 22, 152
delivery systems, 130–140
dementia, 27, 182
Denmark, 50
Department of Health and Human Services (HHS). See patent
dependence, 18, 100, 117, 118, 137, 138, 186, 187, 196, 210
depression, 1, 3, 5, 19, 40, 60–62, 68, 75, 86, 88–90, 92, 95–97, 115, 119, 130, 156, 183, 203
Depression, Great, 6
dermatological conditions, 76
diabetes, 3, 44, 60, 62, 72, 77, 94, 155, 156, 180, 188
diacylglycerol lipase (DAGL), 41
diarrhea, 70, 72, 73
diet, anti-inflammatory, 157–159
disc disease, 62, 63, 73, 131,
dispensaries, 20, 21, 24, 32, 33, 49, 51, 97, 117, 147, 153
distraction, pain, 58, 64, 71
District of Columbia, 15, 17, 22, 59, 123
dosing, xi, 1, 5, 8, 9, 33, 57, 76, 86–89, 94, 99, 104, 120, 122, 129–131, 141
Dravet syndrome, 30–32, 82, 83, 98
driving, 91, 105, 148, 185
dronabinol, 12, 17, 49, 50, 70, 73, 85, 92, 93, 161, 163, 164, 179, 180, 183, 196, 201, 205, 208
drug cartels, 14
drug interactions, 99, 114–116, 121, 125, 140, 185, 187
du Pont, Lammot, 7, 8
dysmenorrhea. See menstrual cramps
dystonia, 23, 27, 82, 88, 182
Ecuador, 18, 169, 210
eczema, 76, 138
edibles, 25, 34, 54, 104, 129, 132, 141, 148
Ehlers-Danlos, 26, 30, 63, 98
Eighteenth Amendment, 6
elderly. See geriatric
emesis. See nausea
emotion, 10, 40, 60, 61, 86, 90, 95, 96, 113, 178, 183
endocannabinoid deficiency syndrome, 77, 80, 155, 172, 180
endocannabinoid overactivity, 77, 180
endocannabinoid signaling, 10, 69, 77, 80, 83, 84, 93, 155, 156, 173, 178, 180, 183, 184, 198
endocannabinoids
2-arachidonoylglycerol (2-AG), 41, 69, 78, 109, 155–157, 174, 189, 191, 204, 209
endocannabinoids, anandamide, 41, 75, 78, 83, 93, 94, 109, 151, 155–157, 174, 185, 189, 191, 193, 195, 196, 203, 204
endocannabinoids, N-arachidonoylethanolamine (AEA), 41, 75
endocannabinoid system (ECS), 40, 41
endometriosis, 140
entourage effect, 42, 52, 174, 175
esophageal spasm, 81
esophagitis, 81
euphoria, 49, 57, 104
extraction, 52
Farm Bill, 2014 13, 152, 153
Farr, Sam (D-CA), 13
fat metabolism, 44, 46, 77, 78, 94, 95, 151
fat-loving (lipophilic), 132, 134, 139
fatigue, 72, 73, 78, 79, 93, 95, 157
fatigue, chronic syndrome, 70, 71
fatty acid amide hydrolase (FAAH), 93, 94, 109, 155, 189
Federal Bureau of Narcotics, 7
fertility, 3, 40, 108, 185
fibroids, 140
fibromyalgia, 40, 63, 70, 77, 172
fibromyalgia, qualifying condition, 20, 22, 23, 27, 28
Filipinos, 7
Finland, 17, 50
flavonoids Cannflavin, A 47
flavonoids Cannflavin, B 47
flavonoids Cannflavin, C 47
flavonoids isovitexin, 48
flavonoids kaempferol, 47, 48
flavonoids luteolin, 47, 176, 202, 210
flavonoids quercetin, 47, 48, 176, 210
flavonoids vitexin, 48
Florida, 15, 22, 152
France, 18, 50
gabapentin, 60, 61, 97
gastritis, 60–62, 73
gastroparesis, 72, 73
gateway drug, 15, 96
Georgia, 15, 18, 30
GERD, 46, 61, 81, 106
geriatrics, 4, 5, 100, 101, 106, 111, 115, 122, 123, 129, 143
Germany, 17, 18, 50, 168, 202
GI motility, 40, 79, 81, 97, 106, 151, 155
Gillibrand, Kristen (D-NY), 13, 36
glaucoma, 77
glaucoma, qualifying condition, 20–31
glucose metabolism, 44, 77, 94, 151, 155, 157, 184, 205
gonads, 40
Good Faith Exam, 124
gout, 2, 63
GPR55. See receptors
Graves’ disease, 70
Greece, 17, 18
Guam, 15, 17, 23
hallucinations, 3, 49, 50, 85, 101, 105, 112, 138
harm reduction, 96, 183, 194
Hashimoto’s thyroiditis, 70
Hawaii, 15, 23, 59, 112, 152
Hearst, William Randolph, 6, 7, 10, 11
heart disease. See cardiac disease
heavy metals, 51, 53, 99, 143, 152
hemp, 2–8, 13, 15, 17, 30–32, 35, 36, 49, 50, 65, 76, 82, 99, 127, 149, 151–153, 165, 167, 172, 209, 210
hemp seeds, 2, 157
hepatitis C, 78, 177, 180, 205
hepatitis C, qualifying condition, 20, 22–29, 33
heroin addiction, 5, 11, 15, 118, 119, 165, 167, 177
hexane, 52, 133
hiccups, intractable, 82
high CBD, states that allow, 15, 30–34
high CBD/low THC, 17, 41, 65, 81–83, 89, 90, 92, 99, 100, 104, 106, 107, 111, 115, 140
HIPAA, 123
hippocampus, 90, 113, 183
Hispanics, 7, 67
Holder, Eric, 19
holy anointing oil, 3
HR 1820, Veterans Equal Access Act, 36, 172, 211
HR 3391, Medical Marijuana Research Act of 2017, 36
HR 3530, Industrial Hemp Farming Act of 2017, 36
Hua Tuo, 2
Human Immunodeficiency Virus (HIV), 18, 49, 50, 67, 78
Human Immunodeficiency Virus (HIV), qualifying condition, 20–29, 31, 33
humulene, 45
Huntington’s disease, 49, 82, 84, 181, 182, 195, 203, 208
Huntington’s disease, qualifying condition, 27, 28
hydrocarbons, 52, 55, 133
hyperemesis syndrome, cannabinoid, 119, 188
hyperlipidemia, 77, 156
hypertension, 73, 77, 101, 107
hypoperfusion, 63, 83, 107
Ibn Sina, 3
ibuprofen, 60–62, 163
Iceland, 50
Idaho, 35, 99, 153, 172
Illinois, 15, 23, 152
India, 3, 4, 15, 17, 31, 148, 152, 165, 169, 171, 187, 205, 210
Indiana, 15, 31, 152
infantile spasms, 4, 82, 98
inflammation, 3, 10, 40, 41, 44–47, 60–63, 66, 67, 69, 70, 74, 76, 79–81, 97, 148, 152, 155–158, 177, 178, 180, 212
inflammation, neuro–, 10, 83–85, 87, 177, 182, 207, 211
inflammatory bowel disease, 20, 21, 23–31, 33, 79–81, 97, 98, 138, 180, 196, 204
inflammatory mediators, 40, 60, 72, 108, 151, 156
inhalation, 86, 87, 108, 127, 130–132, 134–138, 139, 141
insomnia. See sleep
intelligence quotient (IQ), 111, 112, 186
interleukin (IL), 40
interstitial cystitis, 24
intimacy, 95–96
intoxication, 3, 104–105, 117, 118, 137, 138, 140, 178, also See psychoactive
Iowa, 6, 15, 31
Iran, 18
Ireland, 50
irritable bowel syndrome (IBS), 40, 77, 80, 155, 172, 180
Islamic medicine. See Middle Eastern medicine
Israel, 3, 17, 42, 50, 74, 87, 168
Italy, 17, 18, 50, 168
itching, 76
Jamaica, 17, 18
Japan, xi
joint pain. See arthritis
K2, 48
Kampo, xi
kaneh (bosem), 3
Kansas, 6, 15, 35, 99, 153
Kentucky, 15, 31, 152
ketoconazole, 47, 104, 162, 164
Klebsiella, 51
Kozinski, Alex, 19
Kuwait, 50
LaGuardia Committee Report, 9, 10, 11
LaGuardia, Fiorello, 9, 10
Latvia, 18, 170, 197, 203
leaky gut, 79
Lee, Mike (R-UT), 13, 36
legalization, 14, 17–37, 97, 100, 112, 167, 168
Leishmania donovani, 47
lemongrass, 46
Lennox-Gastaut syndrome, 30, 31, 32, 83, 98
lichen planus, 76
Lichtenstein, 50
linalool. See terpenes
lipophilic, 41, 139
Lithuania, 18
Louisiana, 15, 31, 59
lung disease, 51, 57, 75, 76, 108, 188, 201
lupus, 63, 70, 108, 153
lupus, qualifying condition, 23, 24, 26, 30
Luxembourg, 50
Lyme disease, qualifying condition, 30
Lyme disease, 63, 70, 98, 143
Lyrica, 60, 73
Maine, 15, 24, 152
malaria, 2, 45, 79
Malta, 18
marihuana, 7, 8, 10, 11, 12, 25, 165–167, 191, 203, 204, 210
Marihuana Tax Act of 1937, 8
Marinol. See dronabinol, 17
Maryland, 15, 24, 49, 59, 97, 123, 152
Massachusetts, 24
mast cell disorders, 70
Mechoulam, Raphael, 42
medication journal. See Releaf app
melancholia. See depression
Mellon, Andrew, 7, 8
memory, 40, 41, 44, 70, 86, 87, 90, 96, 114, 173, 183, 191, 194
memory, treatment of, 2
menstrual cramps, 9, 140
mental impairment, 63, 111, 112, 114
mercury, 53
metabolic syndrome, 77, 156, 180
methadone, 59, 60, 61, 62, 162
metronidazole (Flagyl), 104, 164
Mexico, 6, 7, 17, 18
Michigan, 15, 25, 152
Middle Eastern medicine, 3, 165
migraines, x, 1, 5, 21, 40, 63, 66, 77, 86, 130, 136, 138, 155, 172
milk, x, 4, 139, 140, 148, 149
Minnesota, 15, 25, 59, 152
mislabeling, 152
Mississippi, 12, 15, 31, 59
Missouri, 15, 32, 152
mixed connective tissue disease, 30, 63, 70
mode of delivery, 130–141
Moldova, 18, 170, 198
Montana, 6, 15, 26, 54, 152
mood, x, 19, 40, 41, 44, 46, 58, 62, 63, 71, 73, 78, 80, 85, 86, 89–92, 96, 97, 151, 155, 156, 183
morphine, 5, 6, 8, 11
Moses, 3
multiple sclerosis, 50, 82, 86
multiple sclerosis, qualifying condition, 20–33
muscle spasm, 5, 15, 42, 45, 46, 48, 49, 61, 63, 64, 66, 68, 81, 82, 86, 88, 138, 149, 151
muscle spasm, qualifying condition, 20–31
myasthenia gravis, 70, 72–73
myclobutanil (pesticide), 53
myofascial pain syndrome, 63
N-arachidonoyl phosphatidylethanolamine (NAPE), 41
Nabilone (Cesamet), 17, 49, 50, 84, 91, 182, 183
nabiximols (Sativex), 17, 49, 50, 181
nausea, 9, 10, 51, 62, 70, 72, 81, 88, 93, 104, 106, 119, 131, 138
nausea, treatment of, 17, 18, 20, 42–44, 49, 50, 73, 75, 76, 78, 136, 139, 141, 151, 153, 180
nausea, qualifying condition, 20–32
Nebraska, 6, 15, 35, 152
nebulizing, 51, 137
Netherlands, 18, 50
neurodegenerative disease, 58, 84–88, 100, 155, 181, 182
neuroinflammation, 10, 83–85, 177, 178
neuropathic pain, 15, 22, 28, 30, 42, 44, 60–68, 78, 86, 88, 97, 137, 138, 151, 153, 178, 179, 188, 189, 208, 212
neuropathy, 60, 61, 63, 66, 67
neuropathy AIDS-related, 63, 78
neuropathy chemo-induced, 60, 63, 73, 75, 76, 179
neuropathy diabetic peripheral, 63, 67, 188
neuropathy radiation-induced, 60, 63, 73, 75, 76
neuropathy, qualifying condition, 21, 23, 26, 27, 31
neuroprotection, 18, 42, 44, 58, 77, 84, 86, 94, 111, 151, 179, 181, 188, 205, 208
Nevada, 6, 15, 26, 54, 124, 152
New Hampshire, 15, 26, 152
New Jersey, 15, 26
New Mexico, 15, 27, 91, 152
New York, 9, 11, 15, 27, 59, 93, 124, 152
New York Academy of Medicine, 9, 10
nicotine, 117–119, 156, 158
Ninth Circuit Court, 19
Nixon, Richard (War on Drugs), 11, 12, 166
North Carolina, 15, 32, 152, 171
North Dakota, 15, 27, 152
Norway, 17, 50, 169
nursing. See breastfeeding
nylon, 7, 8
O’Shaughnessy, “Case of Hydrophobia [Rabies]”, 4
O’Shaughnessy, “Case of Infantile Convulsions”, 4
O’Shaughnessy, “Case of Tetanus”, 4
O’Shaughnessy, “Cases of Rheumatism Treated by Hemp”, 4
O’Shaughnessy, William Brooke, 4
Obama-era enforcement, 12, 13
obesity, 44, 77, 155, 156, 189, 191
Ohio, 15, 28, 112
Oklahoma, 15, 32
Old Testament, 3
On the Preparations of the Indian Hemp, or Gunjah, 4
opiates. See opioids
opioid potentiation, 44, 62, 75, 191
opioid-induced hyperalgesia, 63, 178
opioids, xi, 11, 59–63, 65–68, 73, 75, 96, 97, 103, 110, 115, 121, 122, 167, 170, 177, 178, 191
opium, 5, 6, 11
Oregon, 6, 16, 28, 54, 55, 103, 105, 128, 152
organic, 53–55, 133, 145–147, 149, 158
orgasm, 96
osteoarthritis, 63, 131
Osteopathic Manipulation Therapy (OMT), 157, 159
overdose, cannabis, 51, 139–141, 148, 170
overdose, opiate, 14, 44, 59, 167, 177, 192, 200
overuse of cannabis, 3, 116–119
overuse syndromes, 63
oxycodone, 59, 61, 62, 162
pain, 9, 14, 40–42, 58–66, 72, 76, 77, 79, 81, 86, 91, 97, 98, 100, 102, 111, 177, 178, 194, 207, 211,
cancer-related, 68, 73
pelvic, 140
phantom limb, 63
postoperative, 65–66
qualifying condition, 20–24, 26–29, 31
treatment of, 42, 43, 49, 50, 62–65, 70, 71, 117, 131, 140, 148, 155, 157–159, 169, 183, 191, 203
pancreatitis, qualifying condition, 26
panic attack, x, 88, 89, 136
pantoprazole, 61, 62, 73, 162–164
Paraguay, 18
paranoia, 5, 10, 44, 88, 104, 106, 138, 139
Parkinson’s disease, 84
patent, Department of Health and Human Services, 18
Paul, Rand, 13, 36
pediatric use, 4, 11, 22, 32, 44, 68–70, 82, 83, 97–100, 109, 112, 113, 122, 123, 125, 143, 147, 151, 178, 179, 184, 186, 188
Pen Ts’ao Ching, 2
Pennsylvania, 12, 15, 28, 152
Peru, 17, 18
pesticides, 51–56, 65, 99, 133, 143, 145, 152, 156, 177, 189, 203
pharmaceutical companies, 5, 83
phospholipase C (PLC), 41
physician visit, 20, 121–125
phytocannabinoids. See cannabinoids
pinene. See terpenes
placebo-controlled. See studies
plantar fasciitis, 63
Plasmodium falciparum, 47
Poland, 17, 50, 169, 200
polymyositis, 30, 63
Portugal, 18, 50, 170, 198
post-operative pain, 65, 66
postconcussion syndrome, 24, 83
potentiation, cannabinoid, 101, 119
potentiation, opioid, 44, 62, 75
pregnancy, 109, 185, 186, 193, 194
Princess of Ukok, 2
processed food, 156
propane, 52, 55, 133
Pseudomonas, 51
psoriasis, 21, 45, 70, 76, 138
psoriatic arthritis, 21, 63, 70, 79
psychoactive (psychoactivity), 1, 3, 4, 6, 15, 18, 43, 44, 63, 65, 71, 73, 85–87, 89, 91, 98, 102, 104, 105, 111–113, 117–119, 123, 137–141, 148, 152, 178
PTSD, 58, 90, 91, 97, 155, 183, 194, 201
PTSD, qualifying condition, 20–30, 33
Puerto Rico, 15, 17, 28, 171
pulmonary. See lung disease
Pure Food and Drug Acts, 6
qualifying conditions, 19–35
Quercetin, 17, 28
rabies (hydrophobia), 4
racial issues, 6, 7, 8, 11, 12, 67, 166
ratios, cannabinoid, 39, 48, 64–67, 71, 81, 85, 87–91, 149, 151
ratios, fatty acids, 156, 157, 209
reaction time, 111–113, 119, 124
receptors, cannabinoid
receptors, cannabinoid GPR55, 40, 42, 173
receptors, cannabinoid, CB1, CB2, 40–45, 48, 62, 78, 84, 88, 91, 95, 101, 175, 181, 205
receptors, G protein, 40
Releaf App, 64, 129, 188
Remeron, 80
rheumatism, 2, 4, 22–24, 63, 70, 156
rheumatoid arthritis, 63, 70, 156
rheumatoid arthritis, qualifying condition, 22–24
Rhode Island, 15, 29, 112, 152
Rohrabacher-Blumenauer Amendment, 13
Rohrabacher, Dana (R-CA), 13
Romania, 17, 169, 195
root, cannabis, 47
rosacea, 76
Russia, 2, 18
Russo, Ethan, 77, 172, 207
S 1008, Therapeutic Hemp Medical Access Act of 2017, 36
S 1689, Marijuana Justice Act of 2017, 36
S 1764, The Compassionate Access, Research Expansion, and Respect States Act of 2015 (CARERS), 36
safety profile, 51, 112, 140
salves. See topicals
San Marino, 17, 169, 206
Schafer Commission, 12
scheduling, controlled substance, 12, 14, 15, 18, 33, 36, 75, 98–100, 114, 152, 166, 167, 196
schizoaffective disorder, 30, 90, 92
schizophrenia, 30, 33, 58, 92, 106, 183, 192, 203, 208
Schlichten, George W, 6
seborrhea, 76
seizures, 1, 4, 5, 9, 15, 18, 30, 44, 49, 69, 82, 83, 86, 98, 99, 130, 131, 134, 136, 139, 151, 155
seizures, qualifying condition, 20–32, 34
sensitization, central, 60, 63
serotonin (5-HT1a), 40, 88, 89, 95
serotonin norepinephrine reuptake inhibitors (SNRI), 61
serotonin reuptake inhibitors (SSRI), 89, 119
Sessions, Jefferson, 13–14
sexuality, 3, 95–96, 184
Shen Nung, 2
Shimon Ben-Shabat, 42
Siberian Ice Maiden, 2
sickle cell disease, 21, 28, 30, 63, 67
side effects. See adverse effects
Single Convention on Narcotic Drugs, 11
Sjogren’s syndrome, 24, 70
sleep, 19, 41, 43, 46, 58, 60–63, 65, 67–69, 72, 73, 75, 78, 81, 82, 85–91, 93, 95, 99, 102, 106, 107, 122, 128, 133, 136, 139, 140, 149, 155, 157, 159, 183
sleep apnea, 95
sleep disturbance, x, 68, 90, 157
Slovenia, 18, 170, 198
smoking, 4, 6, 8, 11, 34, 42, 43, 51, 97, 108, 110, 111, 127, 131, 135–137, 139, 156, 188
solvents, residual, 51, 52
solvents. See hydrocarbons
South Africa, 18, 74
South Carolina, 15, 32, 152, 171
South Dakota, 15, 32, 33, 152
Spain, 18, 50, 170, 198
spasmodic torticollis, 27, 88
spasticity, qualifying condition, 21–24, 26–29, 31, 32, 50
spasticity, treatment of, 63, 86, 155
Spice, 48
Standard American Diet (SAD), 156
states, medical cannabis, 19–30
stress, 6, 19, 40, 44, 57, 66, 81, 88, 93, 94, 113, 156–158, 177, 183, 184, 204, 207
stress, oxidative, 45, 67, 83, 84, 87, 151, 176, 178
stress, post-traumatic. See PTSD
stress, reducing, 158
stroke, 83–84, 94, 181, 199
studies, placebo-controlled, 15, 58, 67, 68, 70, 79, 83, 84, 87, 91, 178
sublingual, 63, 64, 69, 87, 89, 99, 131, 132, 134, 135, 139, 141, 145, 147
substance use disorder, 116–119
supercritical carbon dioxide extraction, 55, 133
suppositories, 140
sweet calamus, 3
Switzerland, 18, 50
synthetic cannabis, 48
systemic sclerosis, 63
tamasic, 3
teen. See adolescents
tendonitis, 63, 64
Tennessee, 15, 33, 59, 152
terpenes, 39–43, 45–53, 64, 76, 79, 101, 106, 127, 128, 130, 133, 135, 136, 140, 143, 144, 147, 153, 156, 175
terpenes beta-caryophyllene, 45, 48, 64, 128, 158, 175, 206
terpenes humulene, 45
terpenes limonene, 46, 48, 64, 128, 175, 176, 206, 208
terpenes linalool, 46, 48, 106, 137
terpenes myrcene, 46, 176, 206
terpenes ocimene, 46, 48, 63, 106, 149
terpenes pinene, 6, 176
terpenes terpinolene, 46
terpenes trans-nerolidol, 46
testing, drug, 35, 113
testing, laboratory, 48, 51–56, 133, 144, 145, 152
testing, laboratory, 35, 48, 51–56, 133, 144, 145, 152
testing, neuroeducational, 113, 137
testing, pharmacogenomic, 104
tetanus, 4
tetrahydrocannabinol (THC), xi, 1, 5, 9, 12, 13, 17, 18, 30–35, 41–46, 48–50, 52, 53, 56, 57, 63–77, 79–97, 99, 100, 101, 103–107, 109–117, 119, 121, 125, 127, 128, 130, 134, 135, 137–141, 145–149, 151–153, 162–164
tetrahydrocannabinolic acid (THCA), 18, 34, 42, 52, 71, 72, 74, 76, 99, 137, 145–147
Tetrahydrocannabinolvirdinolic Acid (THCVA), 42, 43
Tetrahydrocannabivarin (THCV), 41–45, 52, 92, 137, 205
Texas, 6, 14, 15, 33
THC-hemisuccinate, 140
therapeutic massage, 60, 157, 159
tincture, 1, 4–6, 9, 29, 51, 54–56, 63–65, 89, 94, 99, 108, 117, 129–135, 137, 139, 141, 145–147, 151
duration of action, 132
how to make, 145–147
onset of action, 132
titration. See dosing
tolerance, 83, 84, 110–111, 117, 118, 137, 138
topicals, x, 28, 34, 63–65, 76, 86, 96, 111, 120, 131, 138, 145
duration of action, 138
onset of action, 131, 138
topoisomerase II, 47
Tourette s